Sunday, March 30, 2008

an exercise in boredom

i have absolutely nothing interesting about which to write, unless you'd like to hear about my housecleaning today. i've been putting off laundry and bird-cage filth for god knows how long. i finally had to rectify that today. i was supposed to work ICU duty, but since there's a mere 1 patient in ICU, i am blissfully free for the rest of the day.

we watched - or rather we tried to watch - "dan in real life" on friday. it was hokey and sentimental, and we didn't make it through the entire film. "enchanted" - the cutesy disney flick - was our back-up plan. it had really funny moments, but overall - it was hokey and sentimental too. **sigh** i'm 0 for 2 on movies this weekend.

oncology kinda sucks. we're too busy to have rounds, so we never get to discuss our cases or chemotherapy regimens or anything really. so honestly, i've learned virtually nothing about cancer. so far the only bright side is that i've gotten to (somewhat) practice my physical exam skills and jugular sticks. that's about the extent of it. we have far too many patients between the 2 of us to actually learn anything.

only a week left before i venture back into the fluorescently lit dimness (not oxymoronic, as you might think) that is the barn/cave. i am trying so hard not to think about it. the only bright side is that i am on with one of my closer friends in the class. oh - and during the 3rd and 4th week (equine surgery), the new, gung-ho to be in clinics, chipper, bright-eyed 4th years (class of 2009) will be with us. thus - we can be *somewhat* slackers.

35 days more to go...

Wednesday, March 26, 2008

some internal switch

has been flipped.

40 days. a month and 10 days. that's all i have left of my time at the university of blank - college of veterinary medicine. in 3 months, i will start my internship.

i have read and re-read notes and books on acid-base balance. i cannot understand it. it doesn't seem like it should be that hard. acids titrate bases. water and carbon dioxide and carbonic anhydrase gives you bicarbonate - which is an important buffer in the body. when the body has too much acid, bad things ensue. but your lungs are there to blow it out in the form of carbon dioxide. and your kidneys are there to buffer it with the increased reabsorption of bicarbonate. WHY is it so hard for me to wrap my mind around the chemical basis of this? why is the henderson-hasselbach equation the bane of every vet students' existence?? if i could thoroughly understand it, just grasp its principle...then i could really understand fluid therapy, electrolyte imbalances...


HA --> <-- H+ + A-

(*ps: i've given up reading 'no country for old men' at the moment and switched over to atonement...)

Tuesday, March 25, 2008

me: 0 aunt flo: 2.5

**the following post might fall under the category of TMI (too much information) for some of my readers. it will discuss the pitfalls of having a uterus/vagina. thus - proceed at your own risk**

this is going to sound un-feminist in the extreme and probably sets the cause of feminism back about 50 years, but i think all women should have 2 days off every month from work, school, motherhood, from plain old life - no questions asked.

ever since i was lucky enough to start my period, it's been a nightmare. you'd think after 14 years of this monthly(ish) torture, i'd be adjusted to it and stop bitching. but such is not the case. i've missed 2.5 days this clinical year for being practically leveled by the cramps, backache, headache, and general hormonal fog that envelopes me the first 2 days of my period.

i've run the gamut as far as BC goes - the patch, the shot, the ring...all coming with more side effects (weight gain, depressive mood swings, WEIGHT GAIN) than they were ultimately worth. plus poor reactions to birth control run in my family. also - i don't like the idea (old-fashioned as this sounds) of manipulating my body's natural(ish) cycles with hormones. it seems unhealthy.

because i can't be anyone else besides myself, i don't know how bad other women have it. i do know that i'm somewhat wimpy. but i also know that my cycles have been prone to lasting 2 weeks uninterrupted, that on the first day, i regularly blow through a super tampon in under 15 minutes repeatedly, and that my waxing/waning migraines are directly related to my periods. fibroid uterine tumors also run in the females of my family - making periods particularly difficult and heavy. mine have never been regulated. recently, they've been somewhat reliable -showing up every 35-40 days. in undergrad and through the first 2 years of vet school, i'd skip a month or 2 quite regularly, guaranteeing that when my period did come round again, it was brutal. if i didn't want kids, i'd have it all ripped out.

in case you missed the implications, i stayed home from school today. i feel terrible about it, because i left my rotation mate alone on oncology - a super-busy service. plus, tonight is our night to work emergency. it's not just the period though, i'm also sick with the head crud. last night was a misery. i woke at 1:30am (after going to bed around 11pm) with stunning cramps that no amount of midol and tylenol could subdue. i crawled to the couch with my heating pad and lay there trying not to cry. i finally fell asleep around 3am. when my alarm sounded at 6:45, i tried to get up. i really did. i dragged myself to the bathroom to shower, but then i realized that no amount of convincing myself i felt better was actually going to make me feel better (or more rested). so i called said rotation-mate, who is very empathetic - and here i am - at home. i actually showered and dressed and headed to school for emergency duty at 4:00pm, but halfway there, i was notified that someone was working emergency for me. so i'm back...sitting on the couch...feeling like a slacker and a whiny female. after all, don't we all have to deal with it?

the one thing that makes me feel doubly bad about all this bitching is the fact that i found a cure for my female problems, and i'm not using it. the summer before last, when i ran the 5k, i found that regular exercise made my cycles regular, less painful, and shorter. it's the only thing that has ever worked for me. i have no idea why and ever since i've stopped exercising, they've been bad again. this is my resolution (once this nightmare week is over) to start exercising again - regularly - if for no other reason than to beat my period back into submission.

Monday, March 24, 2008

pity party - table for 1 please

a hiatus of almost a week. that's how tired i was after medicine. on average, 14 hour days. good friday - despite being a school holiday - i was scheduled to work 8-4pm ICU duty. mercifully, ICU was near empty. i left around 10am. i came home and slept for many, many, many hours (past-dark).

saturday morning was leisurely. i got up early to surprise my husband with a special breakfast. i've been so involved in school and gone so many hours that we've barely seen each other. so i snuck out of the house to buy fresh pineapple and pears, omelet makings, and bacon. i have to say my green pepper, tomato, onion, cheese, and spinach omelet was pretty damned good. afterwards, we took an impromptu drive for 2 hours up to our soon-to-be new home. the day was spent driving around downtown and the surrounding areas looking at neighborhoods and getting a feel for the housing market. i'm falling in love with my future home but feeling more and more anxious about the huge change that's coming. i didn't realize how anxious until the husband pointed out that i was chewing my nails somewhat obsessively while driving. i've never lived in a town where i knew no one - was related to no one. in florida, my grandparents/aunts/uncles were all in the same city. granted, when we first moved here - way back when - i knew no one in this town - but the parents were only an hour and a half away.
change scares me. especially big change. and despite loving veterinary medicine and studying constantly and diligently on my own and spending time at school studying and listening to my clinicians - i realized acutely (during medicine and some already on oncology) how little i know, how limited my experience is, and how VERY much i have to learn. i have this nervous, tingling sensation in my legs frequently when i think about really starting my "adult" life. it's like restless legs syndrome. i want to get up and stalk around the house in an effort to rid myself of this nebulous anxiety/fear.

sunday was spent with the entire family (for once). mom made an excellent ham and turkey dinner. i - however - have finally succumbed to the upper respiratory/head cold that's viciously circulating throughout the vet school. that coupled with the onslaught of my period made me mostly whiny, useless, and pathetic yesterday (and today). not so much that i couldn't enjoy the good food though.

day 1 of oncology (today) was merciless. my group of diseases and the "normal" "natural" feminine processes coupled to almost incapacitate me this morning. there are only 2 of us on the service, myself and a classmate. had that not been the case, i would have called in sick and stayed under the covers, alternately weeping and threatening to break things. we saw 18 or so appointments today. it was a tad overwhelming. at one point, i was so hot and crampy that i actually thought i might faint.

on the way home, i stopped at walgreens and spent $80 on flu/cold medicine, midol, ibuprofen, white grape juice with Vit C, and those stick on heating pads that you wear under your clothes for muscle pain. since i got home, i've been lying on the couch with my heating pad, my dibartola (fluids, electrolytes, and acid-base disorders), and my self-pity trying to remember how calcium homeostasis works.

i'd say tomorrow will be better, but given that we work emergency until 11pm, i HIGHLY doubt it. **sigh** 41 days to go.

Tuesday, March 18, 2008

oh the busy (redux)

today was insane. i love medicine. it's usually hopping, always informing, eternally frustrating and stimulating and utterly infuriating. i arrived at school at 6:30 this morning and didn't leave till 8pm. and i didn't care a bit. i love it. i just (at 11:30) finished my paperwork and will now be retiring to bed since i have to be up loooong before the birds or any other living creature.

i have 3 cases hospitalized but 4 total for the day - i sent one home. my cat that was supposed to have cancer...didn't. my dog that was supposed to NOT have cancer...did. it was a challenging day for multiple reasons. very challenging.

i'm exhausted. i'll post about the 2 cases tomorrow, if i can. i'm hosting a vet school interviewee for the night, so i might not be able to do so. imagine- five years ago - that was me...

Sunday, March 16, 2008

let it be

i knew these owners were going to be trouble when i walked into the room. they were older but no less vocal for it. immediately annoyed that they were dealing with a student, even one as close to graduation as i, it looked like a pain in the ass from the start.

they had brought us their 3 year old maine coon cat. she was in severe respiratory distress when she arrived, and we immediately placed her in an oxygen cage while gathering a history from the owners. she was so distressed that we couldn't place a catheter or get blood or even perform a physical exam on her. nope - it was straight into O2 for her. while she stabilized, i talked to the owners. the story went something like this: her mother was a york chocolate (???) cat and her father was full-blooded maine coon cat. she'd started having breathing problems which the referring vet worked up and diagnosed as asthma. she was placed on an asthma inhaler, maybe steroids (??), and sent home. her condition continued to deteriorate. the owners - alarmed (per their own words) at her health problems, shopped her radiographs around to (by their own admission) 6 other vets asking for 2nd opinions. mind you - they took the radiographs, not the cat to 6 different vets and demanded diagnoses. they insisted to me that all 6 vets adamantly diagnosed heart disease and that all 6 vets verbally lambasted their vet - who made an incorrect diagnosis.

this story immediately set off warning bells in my head. very few vets will ever openly badmouth another vet. most vets will certainly not outright say that another veterinarian made a misdiagnosis without at least seeing the pet in question. but whatever - i decided to ignore this and move on with my discussion of heart disease with them.

**sidenote: what i really think happened here is that the owners self-diagnosed the cat using the good old internet, and then went around to other doctors confirming this diagnosis. and for the record, we talked to one of the vets they saw - and as it went - the owners showed up with radiographs and refused to tell the doctor age, species, sex, or anything else about the cat, demanding a disease diagnosis from the radiographs.***

once they had a diagnosis, they took the cat to the vet mentioned above and demanded an echocardiogram. he conducted it. and then - again per the owners - refused to discuss the results with them. they were extremely huffy about this. infuriated. they spent 5 minutes verbally abusing this veterinarian for his cold-hearted behavior towards them and their cat. they also proceeded to explain - at great length - how the veterinarian's handwriting was so absolutely sloppy that they couldn't read it - and thus, had no real idea what was wrong with their cat.

after talking to them, i examined the cat briefly and found a gallop rhythm (heart sounds like a galloping horse) and decreased compressibility of the chest. the gallop rhythm goes along with heart disease (hypertrophic cardiomyopathy or restrictive cardiomyopathy). the decreased "smooshability" of the chest definitely doesn't. we discussed with the owners our concern that not only did the cat have heart disease but that she might also have a mass in her chest. we then turned our attention to diagnostics. at the very least, we recommended an echocardiogram. these run about $205 at our school (we have 2 board certified cardiologists on staff). before the rest of the plan was out of my mouth, the owners told us they only paid $80 for their original echo. after discussing the benefits of an echo at a teaching institution, they still elected to forego it. they wanted us to prescribe them medications and send the cat home.

sighing, i went to relay this information to my resident clinician. our cardiologist, being the heart lover she is, did a truncated echo on the cat anyway - just to see what she could. sure enough - severe, severe heart thickening and left heart enlargement. so severe that she predicted the cat would be dead in a month or 2. on top of that - there was the issue of muffled / absent heart sounds on the right side of the chest and the firmness of the cat's chest. lymphoma? thymoma? some other weird cancer in the chest? we weren't sure - but we suspected it was there.

i relayed this information to the owners, who again declined all other diagnostics. did i mention that these owners were also self-medicating their cats based on internet information (which, in this case, happened to be sound)? they were also increasing the dose of lasix (a potent diuretic) without consulting their doctor or anyone else. this is dangerous because lasix makes you pee constantly. this incredibly high rate of diuresis can lead to dehydration and electrolyte imbalances rapidly - something these owners (claiming to be well-educated on the subject of feline heart disease) seemed to be ignorant of...

back to the clients i went, explaining to them that our cardiologist wanted to help them out - and had done the echo anyway. i told them of our findings and our desire to keep the cat in ICU. they declined and demanded their cat. i said i would happily procure her, and it would take us a little bit to get the paperwork and prescriptions together. i wasn't gone 5 minutes - working on discharge instructions and prescriptions when the front desk girl came back and told us that the owners were being rude and demanding that we give them their cat so that they could leave. NOTE: these are the people that bitched and moaned that their other veterinarian wouldn't take the time to thoroughly explain the findings of the echocardiogram to them. and here i was - carefully and thoughtfully writing down all our findings, medication recommendations, and prognosis. i returned to the clients and told them that we were getting everything ready - but that it would take a bit. this is - after all - a hospital - NOT the jiffy lube of the pet medical world (ok, that last part was in my head...) i went back to continue gathering everything together - and when i returned - they pointedly told me that they had jobs - you know. ones they had to get back to immediately (they'd been at the vet school maybe - just MAYBE - an hour and a half, at most). this - after we did a free echo on their cat.

finally, everything was complete - including signatures on the paper that said they were taking their cat home against medical advice.

and guess who called me yesterday - asking for us to mail the bloodwork to them - not a referring veterinarian - but to them (we did an electrolyte panel to make sure the cat wasn't a total raisin from fluid loss) so that they could take it to their new vet?

some people make me want to bang my head slowly and repeatedly against a brick wall.